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Predictions of the Impact of Malaria Control Efforts on All-Cause Child Mortality in Sub-Saharan Africa

All-cause childhood mortality (ACCM) has been recommended as an indicator for evaluating the impact of malaria control efforts in parts of Africa where the malaria burden is high and vital registration systems are weak. As ACCM is not malaria-specific, we explored the relationship between ACCM and malaria mortality. First, we show that if malaria mortality is reduced by 50% in populations exposed to high-intensity malaria transmission, ACCM is predicted to decrease by 17% (plausible values range from 12% to 25%). Second, if malaria interventions are scaled-up from very low (2%) to reasonably high coverage levels (70%), epidemiologic models predict that ACCM would decrease by 17% or 18% (precision estimate: 15–19%). These results suggest that if malaria interventions are scaled-up to reach or exceed 70% coverage, it is plausible that a goal of reducing malaria mortality by 50% could be achieved. It is also likely that a pair of "typical"-size mortality surveys could detect this ACCM change as being statistically significant. Although existing models have important limitations, they could be improved by incorporating empirical results during scale-up of multiple interventions and by adding precision estimates and sensitivity analyses.

Received August 21, 2006. Accepted for publication April 13, 2007.

Acknowledgments: The authors thank members of the Roll Back Malaria Monitoring and Evaluation Reference Group and staff from the Malaria Branch of the Centers for Disease Control and Prevention for their critical review of the manuscript. We also thank Gareth Jones, Jeremy Lauer, and Chantal Morel for their help in clarifying methods for the existing published models.

^* Address correspondence to Alexander K. Rowe, Centers for Disease Control and Prevention, Mailstop F22, 4770 Buford Highway, Atlanta, GA 30341-3724. E-mail: axr9{at}cdc.gov

Authors’ addresses: Alexander K. Rowe, Centers for Disease Control and Prevention, Mailstop F22, 4770 Buford Highway, Atlanta, GA 30341-3724, Telephone: +1 (770) 488-3588, Fax: +1 (770) 488-7761, E-mail: axr9{at}cdc.gov. Richard W. Steketee, Program for Appropriate Technology for Health (PATH), Ferney-Voltaire, France.

Reprint requests: Alexander K. Rowe, Centers for Disease Control and Prevention, Mailstop F22, 4770 Buford Highway, Atlanta, GA 30341-3724, Telephone: +1 (770) 488-3588; Fax: +1 (770) 488-7761, E-mail: axr9{at}cdc.gov.

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